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Depression

Once a company has conducted assessment and planning for depression programs, and developed the specific tasks of implementation for these programs, it is time to develop the evaluation plan. This evaluation plan should be in place before any program implementation has begun.

Metrics for worker productivity, health care costs, heath outcomes, and organizational change allow measurement of the beginning (baseline), middle (process), and results (outcome) of workplace health programs. It is not necessary to use all these metrics for evaluating programs. Some information may be difficult or costly to collect, or may not fit the operational structure of a company. These lists are only suggested approaches that may be useful in designing an evaluation plan.

These measures are designed for employee group assessment. They are not intended for examining an individual’s progress over time, which would raise concerns of employee confidentiality. For employer purposes, individual-level measures should be collected anonymously and only reported (typically by a third party administrator) in the aggregate, because the company’s major concerns are overall changes in productivity, health care costs, and employee satisfaction.

In general, data from the previous 12 months will provide sufficient baseline information and can be used in establishing the program goals and objectives in the planning phase, and in assessing progress toward goals in the evaluation phase. Ongoing measurements every 6 to 12 months after programs begin are usually appropriate measurement intervals, but measurement timing should be adapted to the expectations of the specific program.

The mental health of workers is an area of increasing concern to organizations. Depression is a major cause of disability, absenteeism, presenteeism, and productivity loss among working-age adults. The ability to identify major depression in the workplace is complicated by a number of issues such as employees’ concerns about confidentiality or the impact it may have on their job that cause some people to avoid screening.

In a given year, 18.8 million American adults (9.5% of the adult population) will suffer from a depressive illness1

It is estimated that 20% of people aged 55 years or older experience some type of mental health issue. Depression is the most prevalent mental health problem among older adults2

Approximately 80% of persons with depression reported some level of functional impairment because of their depression, and 27% reported serious difficulties in work and home life3

Only 29% of all persons with depression reported contacting a mental health professional in the past year, and among the subset with severe depression, only 39% reported contact3

In a 3-month period, patients with depression miss an average of 4.8 workdays and suffer 11.5 days of reduced productivity1

In 2003, national health expenditures for mental health services were estimated to be over $100 million4

Depression is estimated to cause 200 million lost workdays each year at a cost to employers of $17 to $44 billion5,6

Research shows that rates of depression vary by occupation and industry type. Among full-time workers aged 18 to 64 years, the highest rates of workers experiencing a major depressive episode in the past year were found in the personal care and service occupations (10.8%) and the food preparation and serving related occupations (10.3%)7

Occupations with the lowest rates of workers experiencing a major depressive episode in the past year were engineering, architecture, and surveying (4.3%); life, physical, and social science (4.4%); and installation, maintenance, and repair (4.4%)7

Depression is a complex condition characterized by changes in thinking, mood, or behavior that can affect anyone. Depression is influenced by a number of factors such as genetics; physiology (e.g., neurotransmitters), psychology (e.g., personality and temperament), gender, and the environment (e.g., physical environment and social support). Depression in working populations is equally complex and the causes are not well understood. However, there is recognition that both work and non-work related risk factors play a role such as the effects of worksites that produce excessive job stress on employees and employees’ depression effect on the worksite.8

Evidence linking work organization with depression and other mental health problems, and with increased productivity losses, is beginning to accumulate. A number of studies of a diverse group of occupations have identified several job stressors (e.g., high job demands; low job control; lack of social support in the workplace) that may be associated with depression. Although the evidence is mounting of the links between job stress and depression, there is less evidence of effective interventions to prevent depression in the workplace. There is a need to better understand organizational practices to reduce job stress, and aspects of job design that contribute to poor mental health, so that interventions can be developed to interventions that effectively target these risk factors in the workplace.9

However, there are a number of strategies employers can pursue to support employees’ mental health such as holding depression recognition screenings; placing confidential self-rating sheets in cafeterias, break rooms, or bulletin boards; promoting greater awareness through employee assistance programs (EAP); training supervisors in depression recognition; and ensuring workers' access to needed psychiatric services through health insurance benefits and benefit structures.

In addition to its direct medical and workplace costs, depression also increases health care costs and lost productivity indirectly by contributing to the severity of other costly conditions such as heart disease, diabetes, and stroke. However, routine, systematic clinical screening can successfully identify patients who are depressed, allowing them to access care earlier in the course of their illnesses. Research suggests that 80% of patients with depression will improve with treatment.10

Healthier employees are less likely to call in sick. Companies can sometimes assess sick day use to determine whether health programs are increasing worker productivity.

Baseline

Determine the average number of sick days per employee over the previous
12 months related to depression

This measure may be less useful if there has been a large increase
or decrease in numbers of employees over the past 12 months

It may be difficult to measure when employees take sick leave
directly related to depression, since employees may not report
depression or even recognize they have depression. For example, they may
have headaches, difficulty sleeping, or other symptoms of depression and
report these problems as the cause of their absence. It may be more
useful to measure sick leave related to formal counseling and treatment
services

Determine the costs of worker absenteeism related to depression,
including costs of replacement workers, costs in training replacement
workers, and loss and delay in productivity. See note above regarding
difficulty of measuring absenteeism related to depression

Additional validated surveys have been developed to provide employers with information about the indirect costs of untreated or undertreated employee health issues such as depression. Employers who use these health and productivity surveys on an ongoing basis can begin to evaluate the return on investment (ROI) of offering depression programs on employee absence or productivity. These surveys may be proprietary and may require a modest fee to use. Two examples are provided below:

Health and Work Performance Questionnaire (HPQ) is a short, easy to administer self-report survey designed to estimate workplace indirect costs (absenteeism, reduced productivity, and injury due to accidents) of employee health problems developed by the World Health Organization (WHO) and the Harvard Medical School

Re-assess the average number of sick days per employee at the first
follow-up evaluation See note above regarding difficulty of measuring
absenteeism related to depression

If employee education programs are successful, these measures may
increase in the short term as screening and detection rates increase
(This comment on education only applies to using sick leave or time off
to obtain a clinical preventive service)

Periodic repeats of baseline measures

Outcome

Assess changes in the average number of sick days per employee in
repeated follow-up evaluations. See note above regarding difficulty of
measuring absenteeism related to depression

Assess changes in time employees spend during working hours participating in worksite supported depression-related worksite programs

The effectiveness of depression programs depends on the intensity of program effort and the use of multiple interventions. A rule of thumb is that the more programs implemented together as a package or campaign, the more successful the interventions will be.

Depression prevention and treatment requires ongoing support from employers. New programs can be added over time and evaluated periodically for their effectiveness. For best results, recognition of the benefits of detecting and treating depression should become an inherent part of organizational change and corporate culture.

Measuring organization change is an assessment of company-initiated programs and policies that affect most employees regardless of their health status (e.g., establishing an Employee Assistance Program). These efforts need to be integrated for greatest effectiveness and will require time for full implementation. Regular measures of employee attitudes and program development are key in determining whether new programs are effective or require further adaptation to prevent continuing investment in ineffective efforts.

Baseline

Determine workplace barriers to employee’s awareness and use of
depression-related workplace programs and benefits

Assess current workplace depression-related programs

List current depression prevention options for employees through
worksite and identify number of employees (i.e., participation) using
each option. Examples:

Number of depression-related programs (e.g., education seminars,
individual education, EAP services) and participation in these
programs

Number of training programs related to factors than may impact employee mental health such as conflict resolution, problem solving, effective communications, and job stressors and participation in these training programs

Availability of educational materials on depression prevention
and recognition

Measure reductions in the number and type of employee barriers for
awareness and use of depression-related workplace programs and benefits

Assess changes in workplace depression-related programs including
progress in achieving goals and in implementation of each intervention
(e.g., length of time and timing of tasks to develop, initiate, and conduct
a mass campaign)

Measure changes in the number of depression prevention options for
employees through the worksite and changes in employee participation
using each option before and after the depression-related program or
campaign. Examples:

Number of new programs developed and offered to employees and
participation in these programs (e.g., EAP services)

Number of new training programs developed and offered to employees and participation in these program (e.g., conflict resolution)

Number of new educational materials developed and made available to employees

Number new of health-related policies and environmental strategies to create supportive mental health work environments

Number of new organizational practices that address job stressors (e.g., high job demands; low job control) such as training or job modification

Number of new employee engagement/climate surveys to elicit information on trust and relationships between employees, coworkers, and supervisors

Number of new partnerships with community groups to enhance
access and opportunity for employee depression prevention and
treatment such as local mental health services programs or extended
EAP services

Assess changes in program costs from baseline

Increases in staffing or equipment needs due to new program
offerings

Changes in employee time to participate in programs during work
hours (e.g., education or counseling)

Changes in costs of EAP services

Assess changes in survey responses for employee satisfaction following
implementation of a workplace supported depression-related program and
compare to baseline

CDC Health Scorecard [PDF – 3.5MB]
developed by the Centers for Disease Control and Prevention (CDC), the Health Scorecard is a tool designed to help employers assess the extent to which they have implemented evidence-based health promotion interventions or strategies in their worksites to prevent heart disease, stroke, and related conditions such as hypertension, diabetes, and obesity.

The Substance Abuse and Mental Health Services Administration (SAMHSA)
publishes regular reports from the National Survey on Drug Use and Health.
State estimates on
depression rates can be used for benchmarking

The CDC Healthy Communities Program developed the Community Health Assessment and Group Evaluation (CHANGE) assessment tool to provide communities with a picture of the policy, systems, and environmental change strategies currently in place throughout the community, where gaps exists and facilitate action planning for making improvements. The CHANGE tool address five community sectors including worksites and health indicators related to physical activity, nutrition, tobacco use, chronic disease management, and leadership